Abstract

BACKGROUND: A major public health concern is the growing incidence of the sexually transmitted human papillomavirus (HPV) infection. The highest rate of HPV is found in college-age students with persistent infection noted in young African-American women (AAW). Certain oncogenic strains of HPV can lead to cervical cancer, and in the United States, AAW are more likely to die of cervical cancer than any other racial/ethnic group. While the causes of this disparity is multifactorial, past studies indicate that young AAW have limited understanding of the etiology, modes of transmission, risk, prevention, and treatment of cervical cancer. While screening before the age of 21 is not recommended, providing appropriately-tailored education to young adult AAW can assist in achieving health-promoting behavior and provide opportunity to reduce mortality risk. As a first step, this study sought to expand the paucity of research that focuses on knowledge and attitudes toward HPV and cervical cancer among AAW attending a historically black college and university (HBCU).

METHOD: We conducted a quantitative cross-sectional survey of English-speaking, self-identified AAW or African descent, 18-26 years old, recruited from a HBCU in the mid-Atlantic region of the United States. Consenting participants completed a survey battery to assess knowledge and attitudes toward HPV and cervical cancer, sexual practices, sources utilized for health literacy, and demographic characteristics. Cumulative and individual knowledge scores were calculated for each participant, and analysis was performed to identify items associated with adequate knowledge scores. Pearson's correlation analysis was computed to examine relationships between HPV and cervical cancer knowledge, attitudes and health beliefs.

RESULTS: The sample included 298 AAW undergraduate respondents (25% freshmen, 22.1% sophomores, 20.5% juniors, and 31.5% seniors). The AAW in this sample reported moderate knowledge of HPV with scores ranging from 1 to 13 (M =7.84, SD=1.92); however, individual item analysis suggests there were deficits in basic knowledge (etiology and transmission of HPV, screening and prevention strategies). Approximately 40% of the respondents reported receiving the HPV vaccination. Three fourths of the participants indicated that that they have had two or more sexual partners, while 40% indicated that they do not use protection during sexual practices. The respondents felt that their best source for health literacy was from family and friends (67.8%). Cancer screening attitudes were associated with greater HPV knowledge (r=.173, p<.01). Stronger feelings of fatalism were negatively correlated with HPV knowledge (r=-.158, p<.01). These findings suggest that the more participants are in control of their health, the less likely they exhibit fatalistic or pessimistic attitudes toward cervical cancer.

CONCLUSIONS: Consistent with prior research, the current findings revealed gaps in HPV/cervical cancer knowledge and preventive behaviors. Individual analysis further revealed deficits in knowledge of HPV and cervical cancer, unsafe sexual practices, and fatalistic attitudes. Recommendations for developing reliable educational programs within colleges to better equip students with preventive and positive health strategies should be encouraged. Ultimately, identifying knowledge gaps within this at-risk population would highlight where interventions need to be directed.